Mutant cell-free dna isolation kit and mutant cell-free dna isolation method using the same

ABSTRACT

The present disclosure relates to a mutant cell-free DNA isolation kit and a mutant cell-free DNA analysis method using a CRISPR-Cas system and an exonuclease.

TECHNICAL FIELD

The present disclosure relates to a mutant cell-free DNA isolation kit and a mutant cell-free DNA isolation method using the same. More particularly, the present disclosure relates to a mutant cell-free DNA isolation kit and a mutant cell-free DNA isolation method, both using a CRISPR-Cas system and an exonuclease, for detecting a mutant DNA in a trace amount of a cell-free DNA sample.

BACKGROUND ART

Recently, the importance of early diagnosis of cancer diseases is emerging globally. Thus, researches on methods for early diagnosis of cancer are increasing. However, the current cancer diagnosis methods are mainly invasive methods such as extraction of tissue samples, endoscopy, etc. Because the existing methods involve extraction of a part suspected with a disease and observation with a microscope, they are disadvantageous in terms of patient inconvenience, scarring and long recovery time.

As an alternative to the existing invasive diagnosis and test methods, molecular diagnosis using liquid biopsy is drawing attentions. Because liquid biopsy uses a non-invasive method, the test result can be acquired quickly and multiple analysis of the disease is possible with body fluid, or a liquid biopsy sample, unlike the tissue sample which allows only partial analysis. In particular, liquid biopsy is expected to exhibit excellent efficiency in cancer diagnosis. It is also expected that carcinogenesis, metastasis, etc. can be observed in detail through analysis of cancer cell-derived DNAs existing in body fluid such as blood, urine, etc.

Recently, in the context with liquid biopsy, cell-free DNAs (cfDNAs) which are released from tumors to bloodstream and existing in blood are studied actively. With the advancement in the technologies of isolating and detecting cfDNAs from various biological samples such as blood, plasma, urine, etc., liquid biopsy will become a more effective and trustable tool for monitoring of patients suspected of having cancer. Cancer-derived cfDNAs were identified in 75% of more of patients with progressive pancreatic cancer, ovarian cancer, colon cancer, bladder cancer, gastroesophageal cancer, breast cancer, melanoma, hepatocellular carcinoma, and head and neck cancer, and in 50% of more of patients with kidney cancer, prostate cancer or thyroid cancer. In genetic clinical diagnosis for patients with metastatic colon cancer, cfDNA showed 87.2% sensitivity and 99.2% specificity of KRAS DNA mutations.

Since these researches show the possibility of cancer diagnosis through cfDNA analysis, a cancer-derived DNA in cfDNA is drawing attentions as next-generation biomarker. An initial-phase tumor is diagnosed by identifying tumor-specific DNA mutation from cfDNA derived from a cancer patient. However, there are many technical limitations in early diagnosis of cancer through detection of DNA mutation by analyzing cfDNA in a liquid sample such as blood, urine, etc. (patent document 1). In particular, cfDNA exists in a urine, cerebrospinal fluid, plasma, blood or body fluid sample at a very low concentration and DNA mutation may occur naturally with the aging of cfDNA. Because most of cfDNA present in the plasma of a patient is a wild-type (wt) DNA derived from a normal somatic cell, it is almost impossible to accurately diagnose the presence of a cancer cell-derived DNA from cfDNA with the current sequencing technology. Therefore, in order to diagnose cancer in the early phase with a trace amount of cfDNA, it is necessary to remove normal DNAs and specifically amplify the cancer cell-derived DNA. Thus, a method for improving detection sensitivity and enabling accurate early diagnosis of cancer is necessary.

Meanwhile, the currently developed genome editing based on a Clustered Regularly Interspaced Short Palindrome Repeats (CRISPR) associated endonuclease (Cas) provides a breakthrough technology for target gene knock-out, transcriptional activation and gene correction. This technology demonstrates expandability by targeting numerous DNA locations. The CRISPR-Cas system is composed of a guide RNA (gRNA) having a sequence complementary to a targeted DNA or nucleic acid) and the CRISPR enzyme, which is a nuclease capable of cleaving the targeted DNA or nucleic acid. The gRNA and the CRISPR enzyme form the CRISPR-Cas complex, and the formed CRISPR-Cas complex cleaves or modifies the targeted DNA or nucleic acid. The CRISPR system is recently studied a lot with regard to applicability as DNA scissors, as an immune system of prokaryotes and archaea (non-patent document 1, non-patent document 2). However, there has been no attempt to use it for base sequence capturing used in genome sequencing and diagnosis of a disease.

The inventors of the present disclosure have made efforts to find a method for isolating a mutant DNA from cfDNA. As a result, they have completed the present disclosure by using a technology of specifically cleaving a normal DNA from a trace amount of cfDNA using the CRISPR-Cas system and a technology of specifically amplifying a mutant DNA.

-   (Patent document 1) Korean Patent Publication No. 10-2016-0129523. -   (Non-patent document 1) Jinek et al. Science, 2012, 337, 816-821. -   (Non-patent document 2) Zalatan et al. Cell, 2015, 160, 339-350. -   (Non-patent document 3) Tian J, Ma K, Saaem I., Mol Biosyst, 2009,     5(7), 714-722. -   (Non-patent document 4 Michael, L. Metzker, Nature Reviews Genetics,     2010, 11, 31-46.

DISCLOSURE Technical Problem

The present disclosure is directed to providing a mutant cell-free DNA isolation kit.

The present disclosure is also directed to providing a mutant genotype analysis method.

Technical Solution

The present disclosure provides a mutant cell-free DNA isolation kit including: a composition for amplifying a wild-type cell-free DNA and a mutant cell-free DNA, which contains a 5′ end-protected primer;

a guide RNA specific for the wild-type cell-free DNA;

a Cas protein for cleaving the wild-type cell-free DNA; and

an exonuclease for removing the wild-type cell-free DNA.

The mutant cell-free DNA may be a DNA including a cancer-specific mutation.

As used herein, the term “cell-free DNA (cfDNA)” refers to a cancer cell-derived DNA which originates from a tumor cell and can be found in a biological sample such as blood, plasma, urine, etc. derived from a cancer patient. It is activated in necrotic or apoptotic normal and/or cancer cells and released into urine, blood, etc. through various cytophysiological processes. Because urine, cerebrospinal fluid (CSF), plasma, blood or body fluid are readily available samples, it can be collected in large quantities via a simple, non-invasive method through repeated sampling.

As used herein, the “CRISPR-Cas system” is composed of a guide RNA (gRNA) having a sequence complementary to a targeted DNA or nucleic acid and the CRISPR enzyme, which is a nuclease capable of cleaving the targeted DNA or nucleic acid. The gRNA and the CRISPR enzyme form the CRISPR-Cas complex, and the formed CRISPR-Cas complex cleaves or modifies the targeted DNA or nucleic acid.

The Cas protein is an essential protein component of the CRISPR-Cas system. When two RNAs called the CRISPR RNA (crRNA) and the transactivating crRNA (tracrRNA) form a complex, an activated endonuclease is formed. The information of the Cas gene and protein is available from the GenBank of the National Center for Biotechnology Information (NCBI), although not being limited thereto.

As used herein, the term “guide RNA” refers to an RNA specific for a target DNA, which is synthesized through transcription of a linear double-stranded DNA or chemical synthesis, is capable of recognizing a target DNA sequence and forming a complex with the Cas protein, and guides the Cas protein to the target DNA. The “target DNA sequence” is a nucleotide sequence present in the target DNA or nucleic acid. Specifically, it is a portion of a nucleotide sequence in a target region of the target DNA or nucleic acid. The “target region” is a region in the target DNA or nucleic acid that can be modified by a guide nucleic acid-editor protein complex.

As used herein, the term “PAM (PAM; protospacer adjacent motif) sequence” refers to sequence with a size of about 3-6 bp, adjacent to a target sequence. It is an essential component recognized by the Cas protein. The CRISPR-Cas complex recognizes the target and PAM sequence and cleaves a specific location.

The kit may be for isolating a mutant cell-free DNA from a wild-type cell-free DNA and a mutant cell-free DNA contained in a liquid sample (blood, plasma, urine, etc.) isolated from an individual suspected with cancer.

The Cas protein may be Streptococcus pyogenes Cas9 (SpCas9), Streptococcus thermophilus Cas9 (StCas9), Streptococcus pasteurianus (SpaCas9), Campylobacter jejuni Cas9 (CjCas9), Staphylococcus aureus (SaCas9), Francisella novicida Cas9 (FnCas9), Neisseria cinerea Cas9 (NcCas9), Neisseria meningitis Cas9 (NmCas9), or CRISPR-associated endonuclease in Prevotella and Francisella 1 (Cpf1), although not being necessarily limited thereto.

The information about the Cas protein or gene may be obtained from a publicly available database such as the GenBank of the NCBI (National Center for Biotechnology Information), although not being limited thereto.

The guide RNA may be a dual RNA (dualRNA) or a sgRNA (single-chain RNA) including a crRNA (CRISPR RNA) and a tracrRNA (transactivating crRNA).

The guide RNA may include two or more guide RNAs specific for a plurality of wild-type cell-free DNAs. That is to say, the kit of the present disclosure is a kit capable of multiplexing.

A method for preparing the guide RNA is widely known in the art.

The 5′ end-protected primer may have the 5′ end of the primer protected with a phosphothioate bond.

The composition for amplifying DNA may be a PCR composition.

In the present disclosure, the term “amplification reaction” refers to a reaction whereby a target nucleic acid sequence is amplified and may be carried out by PCR (polymerase chain reaction). The PCR includes reverse transcription polymerase chain reaction (RT-PCR), multiplex PCR, real-time PCR, assembly PCR, fusion PCR and ligase chain reaction (LCR), although not being limited thereto.

As used herein, the term “primer” refers to a single-stranded oligonucleotide and may also include a ribonucleotide. Specifically, it may be a deoxyribonucleotide. The primer is hybridized or annealed to a region of a template to form a double-stranded structure. In the present disclosure, the primer may be hybridized or annealed to an NGS sequencing adapter sequence. The annealing refers to apposition of an oligonucleotide or a nucleic acid to a template nucleic acid. The apposition allows a polymerase to polymerize a nucleotide, thereby forming a nucleic acid molecule complementary to the template nucleic acid or a portion thereof. The hybridization refers to formation of a duplex structure through pairing of two single-stranded nucleic acids with complementary base sequences. The primer may serve as a starting point of synthesis under a condition where the synthesis of a primer extension product complementary to the template is induced.

The PCR composition may contain, in addition to the 5′ end-protected primer specific for the wild-type cell-free DNA and the mutant cell-free DNA, components widely known in the art. Specifically, it may contain a PCR buffer, a dNTP, a DNA polymerase, etc.

As used herein, the term “exonuclease” refers to an enzyme which cleaves a nucleotide sequentially from the 3′ end or 5′ end of a polynucleotide chain. 3′ to 5′ exonuclease is an enzyme which cleaves a phosphodiester bond at the 3′ end, and 5′ to 3′ exonuclease is an enzyme which cleaves a phosphodiester bond at the 5′ end.

The exonuclease may be any exonuclease known in the art. Specifically, the exonuclease may include 3′→5′ exonuclease and/or 5′→3′ exonuclease. Specifically, it may be exonuclease III, exonuclease I, T5 exonuclease, T7 exonuclease, exonuclease T, exonuclease V, lambda exonuclease, exonuclease VII, etc. More specifically, it may be exonuclease T7 or exonuclease T (single-stranded specific nuclease), although not being necessarily limited thereto.

When a sample containing a wild-type cell-free DNA and a mutant cell-free DNA is reacted with the composition for amplifying DNA containing the 5′ end-protected primer, the ends of the wild-type cell-free DNA and the mutant cell-free DNA are protected with a phosphothioate bond. The protected DNAs are not cleaved by an exonuclease because of the phosphothioate bond.

When a wild-type cell-free DNA is cleaved by a guide RNA and a Cas protein specific for the wild-type cell-free DNA, the unprotected end of the nucleic acid is exposed to an exonuclease. Through this, the wild-type cell-free DNA is removed and only the mutant cell-free DNA is isolated (FIG. 1).

In an example of the present disclosure, when a guide RNA targeting the KRAS gene was used, only the wt KRAS satisfying the 5′-NGG-3′ PAM sequence was cleaved selectively by Cas9. It was confirmed through electrophoresis that the wt KRAS DNA cleaved by Cas9 was removed completely by treatment with exonuclease T7 and exonuclease T.

In another aspect, the present disclosure provides a mutant genotype analysis method including:

i) a step of amplifying a wild-type cell-free DNA and a mutant cell-free DNA in an isolated sample containing at least one wild-type cell-free DNA and at least one mutant cell-free DNA using a 5′ end-protected primer;

ii) a step of cleaving only the amplified wild-type cell-free DNA by treating with a Cas protein and a guide RNA binding specifically to the wild-type cell-free DNA;

iii) a step of removing only the cleaved wild-type cell-free DNA by treating the sample containing the mutant cell-free DNA and the cleaved cell-free DNA with an exonuclease;

iv) a step of amplifying the mutant cell-free DNA remaining in the sample; and

v) a step of analyzing the amplified mutant cell-free DNA.

The isolated sample containing at least one wild-type cell-free DNA and at least one mutant cell-free DNA may be a blood, plasma or urine sample isolated from an individual suspected with cancer.

The mutant cell-free DNA may be a DNA including cancer-specific mutation.

The analysis of the mutant cell-free DNA may be for providing information for diagnosis of cancer.

As used herein, the term “diagnosis” includes to decision of the susceptibility of a subject to a specific disease or disorder, decision of the presence of a specific disease or disorder in a subject, decision of the prognosis of a subject having a specific disease or disorder, or therametrics (e.g., monitoring of the status of a subject in order to provide information for therapeutic effects).

In the present disclosure, the diagnosis may include identification of the onset of cancer and/or prognosis of cancer.

The cancer may be early-stage cancer.

The cancer may be, for example, one or more selected from a group consisting of squamous cell carcinoma (e.g., squamous cell carcinoma of the epithelium), small-cell lung carcinoma, non-small-cell lung carcinoma, lung cancer, peritoneal cancer, colon cancer, bile duct tumor, nasopharyngeal cancer, laryngeal cancer, bronchogenic cancer, oral cancer, osteosarcoma, gallbladder cancer, kidney cancer, leukemia, bladder cancer, melanoma, brain cancer, glioma, brain tumor, skin cancer, pancreatic cancer, breast cancer, liver cancer, bone marrow cancer, esophageal cancer, colon cancer, stomach cancer, cervical cancer, prostate cancer, ovarian cancer, head and neck cancer, and rectal cancer, although not being limited thereto.

The 5′ end-protected primer may have the 5′ end of the primer protected with a phosphothioate bond.

The Cas protein may be Streptococcus pyogenes Cas9 (SpCas9), Streptococcus thermophilus Cas9 (StCas9), Streptococcus pasteurianus (SpaCas9), Campylobacter jejuni Cas9 (CjCas9), Staphylococcus aureus (SaCas9), Francisella novicida Cas9 (FnCas9), Neisseria cinerea Cas9 (NcCas9), Neisseria meningitis Cas9 (NmCas9), or CRISPR-associated endonuclease in Prevotella and Francisella 1 (Cpf1), although not being necessarily limited thereto.

The guide RNA may be a dual RNA (dualRNA) or an sgRNA (single-chain RNA) including a crRNA (CRISPR RNA) and a tracrRNA (transactivating crRNA).

The amplification may be performed by PCR and the PCR condition may be determined based on methods widely known in the art.

Advantageous Effects

A mutant cell-free DNA isolation kit and a mutant cell-free DNA isolation method of the present disclosure use the CRISPR-Cas system and an exonuclease, and allow selective removal of normal somatic cell-derived DNAs, which account for most of cfDNA (>99.9%) in blood. As a result, because only the mutant cell-free DNA (cancer cell-derived DNA) in the cfDNA can be analyzed, it can be usefully used for early diagnosis of cancer.

In addition, the mutant cell-free DNA isolation kit and the mutant cell-free DNA isolation method of the present disclosure provide an effect of allowing the analysis of a trace amount of mutant cell-free DNAs (cancer cell-derived DNAs) existing in cfDNA by removing the normal cell-derived DNAs from the sample.

Furthermore, the present disclosure allows simultaneous detection of two or more oncogenes via a multiplexing system because a guide RNA specific for a plurality of wild-type DNAs.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 schematically shows a procedure of amplifying mtDNA (mutant DNA) only by selectively removing wtDNA (wild-type DNA) from a sample according to the present disclosure.

FIGS. 2a and 2b show a result of selectively cleaving wtDNA in a sample using a CRISPR-Cas system according to the present disclosure.

FIGS. 3a and 3b show a result that a DNA cleaved by the CRISPR-Cas system according to the present disclosure is selectively degraded by an exonuclease.

FIG. 4 shows a result of analyzing a sample with KRAS wtDNA removed by treating with a CRISPR-Cas and an exonuclease according to the present disclosure through next-generation base sequencing.

FIG. 5 shows a result of analyzing a sample with KRAS wtDNA removed by treating with a CRISPR-Cas and an exonuclease according to the present disclosure through Sanger sequencing.

FIG. 6 schematically shows a procedure of amplifying multiple cancer-derived DNAs at once by removing multiple target DNAs through multiplexing by treating with CRISPR-Cas and an exonuclease according to the present disclosure.

FIGS. 7a and 7b show a result of confirming that only a target DNA (wtDNA) can be removed selectively using a multiplexing system by treating with a CRISPR-Cas and an exonuclease according to the present disclosure through agarose gel electrophoresis.

FIG. 8 shows a result of analyzing a sample with KRAS wtDNA and EGFR wtDNA removed using a multiplexing system by treating with a CRISPR-Cas and an exonuclease according to the present disclosure through next-generation base sequencing.

FIG. 9 schematically shows a method of removing DNA using a multiplexing system and a Cas9 orthologue according to the present disclosure.

BEST MODE

The CRISPR-Cas system is an endonuclease with very high accuracy, which is capable of selectively cleaving a target DNA. Cas9 orthologues have different PAM site sequences. The PAM sequence is a DNA sequence essential for the recognition of the target DNA by the Cas9 protein. Even when bound to a guide RNA perfectly complementary to the target DNA, the CRISPR-Cas system does not operate unless the PAM sequence is satisfied. And, if the guide RNA has many DNA sequences non-complementary to the target DNA, the CRISPR-Cas cannot recognize the target DNA normally. In order to identify a cancer gene generated by nucleotide substitution, a guide RNA complementary to a wild-type DNA was designed. The designing of the target of the guide RNA was largely based on two criteria. If the base sequence prior to the occurrence of substitution corresponds to the PAM site, the guide RNA was designed based on the PAM site. Otherwise, if it does not correspond to the PAM site, a mismatch was added to the seed region. The seed region of Cas9 is a region which responds very sensitively to the mismatch between the guide RNA and the target DNA during the recognition of the target DNA. If there is a mismatch of 1-2 nt in the seed region, the target DNA is not recognized clearly.

The guide RNA used in the present disclosure is designed so as to recognize the wild-type DNA selectively.

In the present disclosure, when the target DNA was cleaved by Cas9 and then amplified by PCR, the amplified amount was smaller for the wild-type cell-free DNA cleaved by Cas9 than for the mutant cell-free DNA. However, the detection limit for identifying a trace amount of mutant DNA could not be achieved with a simple method of cleaving the wild-type DNA with Cas9 and conducting PCR for the mutant DNA. Because the fragment of the wild-type DNA cleaved by Cas9 can serve as a primer during PCR, a DNA sequence derived from the wild-type DNA can be included in the finally amplified PCR product. The cleaved DNA fragments intensify the background signal and make it impossible to achieve the detection limit for identifying the trace amount of the cancer-derived DNA (see the left-side box at the bottom of FIG. 1).

However, in the present disclosure, the cleaved fragments of the wild-type DNA, which generate background signals during PCR, are removed to provide sufficient detection ability for a trace amount of the target DNA. When the target DNA is amplified by PCR in the final process of analyzing the trace amount of cfDNA, a primer with the 5′ end protected with a phosphothioate bond is used, or an adaptor containing a phosphothioate bond is ligated on both ends of an amplified PCR amplicon. If the phosphodiester bond connecting nucleotides is replaced with the phosphothioate bond, a nuclease cannot cleave the nucleotides having the bond.

If the target DNA with both ends protected with the phosphothioate bond is treated with an exonuclease, the target DNA is not degraded by the exonuclease. However, if the target DNA is cleaved by Cas9, new DNA ends not protected with phosphothioate are exposed to the exonuclease, and the DNAs cleaved by Cas9 are removed by the exonuclease.

That is to say, the DNA cleavage and removal technologies on the present disclosure play a complementary role, enabling the accurate detection of a cancer-derived DNA in a trace amount of cfDNA, which was not possible before.

In an aspect of the present disclosure, it was confirmed that a complex of the SpCas9 protein and the guide RNA allows accurate cleavage of the target DNA satisfying the PAM sequence of 5′-NGG-3′.

In the present disclosure, the mutation of the KRAS gene is a major mutation of the cancer gene, and is an important biomarker for cfDNA. The frequently occurring mutation of KRAS is change of the 12nd amino acid from aspartate to valine due to the substitution of the 35th nucleic acid on the cDNA from G to T. For the mtDNA with the 35th nucleic acid substituted from guanosine to thymidine, the base sequence corresponding to PAM of Cas9 on the substituted target DNA is changed to NGT. SpCas9, which specifically recognizes NGG as a PAM sequence, specifically recognizes wt KRAS only from wt KRAS and mt KRAS (35G>T) and cleaves the DNA (FIG. 2).

Hereinafter, the present disclosure will be described in detail through examples. However, the following examples are for illustrative purposes only and it will be apparent to those of ordinary skill in the art that the scope of the present disclosure is not limited by the examples.

Example 1: Isolation and Purification of SpCas9

For expression of the recombinant Streptococcus pyogenes Cas9 (spCas9) protein containing a His×6 tag at the N-terminal, a plasmid having the genetic information of spCas9 (full sequence of the protein including the His×6 tag, SEQ ID NO 1) was transformed into BL21-DE3 competent cells. After IPTG (isopropyl β-D-thiogalactoside) treatment, the BL21-DE3 were cultured at 18° C. for 16 hours. The cells were centrifuged at 5000×g for 15 minutes and then lysed with a lysis buffer containing 50 mM (pH 8) NaH₂PO₄, 400 mM NaCl, 10 mM imidazole, 1 mM PMSF, 1 mM DTT, 1% Triton X-100 and 1 mg/mL lysozyme. After sonicating using an ultrasonicator, the cells were centrifuged at 15000×g for 30 minutes and the supernatant was separated from the cell debris. After adding a nickel-nitrilotriacetic acid (Ni-NTA) resin (Invitrogen, Carlsbad, Calif.) to the supernatant and incubating at 4° C. for 1 hour, the Ni-NTA resin was washed repeatedly twice with a washing buffer (50 mM (pH 8) NaH₂PO₄, 400 mM NaCl, 20 mM imidazole). Finally, spCas9 was separated from the Ni-NTA resin by adding an elution buffer (50 mM (pH 8) NaH₂PO₄, 400 mM NaCl, 250 mM imidazole) to the resin. The buffer containing spCas9 was replaced with a buffer containing 20 mM (pH 7.5) HEPES, 400 mM NaCl, 1 mM DTT and 40% glycerol using an Amicon Ultra centrifugal filter.

Example 2. Synthesis of Guide RNA by In Vitro Transcription

A guide RNA was synthesized in vitro by reacting a DNA template containing guide RNA information and a T7 RNA polymerase in a buffer containing 40 mM Tris-HCl (pH 7.9), 6 mM MgCl₂, 10 mM DTT, 10 mM NaCl, 2 mM spermidine, NTP and Rnase inhibitor at 37° C. for 18 hours (SEQ ID NOS 2 and 3). The synthesized guide RNA was purified using an RNA purification kit.

Example 3. In Vitro Cleavage

500 ng of the SpCas9 (hereinafter, denoted as Cas9) isolated and purified according to Example 1 and 100 ng of the guide RNA prepared according to Example 2 were bound at 37° C. for 5 minutes, and then reacted with 150 ng of the wild-type KRAS gene (SEQ ID NO 4) and the mutant KRAS gene (KRAS D12V, SEQ ID NO 6), which are double-stranded DNAs (dsDNAs), in a buffer (50 mM (pH 7.9) potassium acetate, 20 mM Tris-acetate, 10 mM magnesium acetate, 1 mM DTT) at 37° C. for 60 minutes. The information of the KRAS gene and its amino acid sequence is given in Table 1.

TABLE 1 In-vitro DNA substrate Sequence SEQ ID NO 4: gtttgtttgttttgagatggagtcttactccgtcacccaatctggagtgcagtggcgtgatctgggctc sequence of actgcaacctctgcctcccgggttcaagtgattctccttcctcagcctccccagtagctaggactacag wild-type KRAS gagagcgccaccacgcctgattaatttttgtatttttagtagagagagggtttcaccatattggccagg (2787 nt) ctggtcttgaactcctggcctcaggtgatccacccgccttggcctctgaaagtgctgggattacaggca tgagccgccgcacccggctttctaatctttatctttttttgtgcagcggtgatacaggattatgtattg tactgaacagttaattcggagttctcttggtttttagctttattttccccagagatttttttttttttt tttttttttgagacggagtcttgctctatcgccaggctggagtgcagtggcgccatctcggctcattgc aacctcggactcctattttccccagagatatttcacacattaaaatgtcgtcaaatattgttcttcttt gcctcagtgtttaaatttttatttccccatgacacaatccagctttatttgacactcattctctcaact ctcatctgattcttactgttaatatttatccaagagaactactgccatgatgctttaaaagtttttctg tagctgttgcatattgacttctaacacttagaggtgggggtccactaggaaaactgtaacaataagagt ggagatagctgtcagcaacttttgtgagggtgtgctacagggtgtagagcactgtgaagtctctacatg agtgaagtcatgatatgatcctttgagagcctttagccgccgcagaacagcagtctggctatttagata gaacaacttgattttaagataaaagaactgtctatgtagcatttatgcatttttcttaagcgtcgatgg aggagtttgtaaatgaagtacagttcattacgatacacgtctgcagtcaactggaattttcatgattga attttgtaaggtattttgaaataatttttcatataaaggtgagtttgtattaaaaggtactggtggagt atttgatagtgtattaaccttatgtgtgacatgttctaatatagtcacattttcattatttttattata aggcctgctgaaaatgactgaatataaacttgtggtagttggagctggtggcgtaggcaagagtgcctt gacgatacagctaattcagaatcattttgtggacgaatatgatccaacaatagaggtaaatcttgtttt aatatgcatattactggtgcaggaccattctttgatacagataaaggtttctctgaccattttcatgag tacttattacaagataattatgctgaaagttaagttatctgaaatgtaccttgggtttcaagttatatg taaccattaatatgggaactttactttccttgggagtatgtcagggtccatgatgttcactctctgtgc attttgattggaagtgtatttcagagtttcgtgagagggtagaaatttgtatcctatctggacctaaaa gacaatctttttattgtaacttttatttttatgggtttcttggtattgtgacatcatatgtaaaggtta gatttaattgtactagtgaaatataattgtttgatggttgatttttttaaacttcatcagcagtatttt cctatcttcttctcaacattagagaacctacaactaccggataaattttacaaaatgaattatttgcct aaggtgtggtttatataaaggtactattaccaactttacctttgctttgttgtcatttttaaatttact caaggaaatactaggatttaaaaaaaaattccttgagtaaatttaaattgttatcatgtttttgaggat tattttcagatttttttagtttaatgaaaatttaccaaagtaaagaccagcagcagaatgataagtaaa gacctgtaagacaccttgaaggtcatggagtagaacttccatcccaagcagatgaggatttatttaatc tcaaagacctccaggaggggacattccccaactgtccttgttaactcattttcagaacatatttattag catattttacatgtaatttggatcttcatgttaaatttaacatcagtggagatggaaaataagcatatc gccttgtctttgaaatagccctatattgttagattgtttcttaggcttctttaccctgggttaagcagt cctaatactttagcatttattctacatctagtgtactaatttaaaaaaatcagttctgaaaaatttcta agaactttcttcaagttccaagctgtgaaatctagaacaggtcaaagtgccttattaacgtactgtact gtgtagtgtcttgaagagacactttgcgctgaggcaagttctgagggcattgggtggccttgggaagat atttatgcagtttagaacctggagaattgattagataactaatcataaggaaacgtcacatatttttgg tactataaaaaagtggagaaataatgcctatttgcaaagatttgatttaaacatagaaacaactttatt tggcttccaattttaagaatttacagcagtaaaggggaacagtctaattgaagtagactgcctatgcaa tagtctctgtatatttacttttgacaagttaattcaatgtgtactatagttttgtttctttgaagaggt ttgaatagtgcacccattttaatctgt Underline: exon 1 SEQ ID NO 5: MTEYKLVVVGAGGVGKSALTIQLIQNHFVDEYDPTIE DSYRKQVVIDGETCLLDILDTAGQEEYSAMRD amino acid QYMRTGEGFLCVFAINNTKSFEDIHHYREQIKRVKDSEDVPMVLVGNKCDLPSRTVDTKQAQDLARSYG sequence of wild- IPFIETSAKTRQRVEDAFYTLVREIRQYRLKKISKEEKTPGCVKIKKC type KRAS from Underline: KRAS exon 1 exon 1 Shade: G12V mutation SEQ ID NO 6: gtttgtttgttttgagatggagtcttactccgtcacccaatctggagtgcagtggcgtgatctgggctc sequence of actgcaacctctgcctcccgggttcaagtgattctccttcctcagcctccccagtagctaggactacag mutant KRAS gagagcgccaccacgcctgattaatttttgtatttttagtagagagagggtttcaccatattggccagg c.G35 > T target ctggtcttgaactcctggcctcaggtgatccacccgccttggcctctgaaagtgctgggattacaggca (2787 nt) tgagccgccgcacccggctttctaatctttatctttttttgtgcagcggtgatacaggattatgtattg tactgaacagttaattcggagttctcttggtttttagctttattttccccagagatttttttttttttt tttttttttgagacggagtcttgctctatcgccaggctggagtgcagtggcgccatctcggctcattgc aacctcggactcctattttccccagagatatttcacacattaaaatgtcgtcaaatattgttcttcttt gcctcagtgtttaaatttttatttccccatgacacaatccagctttatttgacactcattctctcaact ctcatctgattcttactgttaatatttatccaagagaactactgccatgatgctttaaaagtttttctg tagctgttgcatattgacttctaacacttagaggtgggggtccactaggaaaactgtaacaataagagt ggagatagctgtcagcaacttttgtgagggtgtgctacagggtgtagagcactgtgaagtctctacatg agtgaagtcatgatatgatcctttgagagcctttagccgccgcagaacagcagtctggctatttagata gaacaacttgattttaagataaaagaactgtctatgtagcatttatgcatttttcttaagcgtcgatgg aggagtttgtaaatgaagtacagttcattacgatacacgtctgcagtcaactggaattttcatgattga attttgtaaggtattttgaaataatttttcatataaaggtgagtttgtattaaaaggtactggtggagt atttgatagtgtattaaccttatgtgtgacatgttctaatatagtcacattttcattatttttattata aggcctgctgaaa atgactgaatataaacttgtggtagttggagctgttggcgtaggcaagagtgcctt gacgatacagctaattcagaatcattttgtggacgaatatgatccaacaatagag gtaaatcttgtttt aatatgcatattactggtgcaggaccattctttgatacagataaaggtttctctgaccattttcatgag tacttattacaagataattatgctgaaagttaagttatctgaaatgtaccttgggtttcaagttatatg taaccattaatatgggaactttactttccttgggagtatgtcagggtccatgatgttcactctctgtgc attttgattggaagtgtatttcagagtttcgtgagagggtagaaatttgtatcctatctggacctaaaa gacaatctttttattgtaacttttatttttatgggtttcttggtattgtgacatcatatgtaaaggtta gatttaattgtactagtgaaatataattgtttgatggttgatttttttaaacttcatcagcagtatttt cctatcttcttctcaacattagagaacctacaactaccggataaattttacaaaatgaattatttgcct aaggtgtggtttatataaaggtactattaccaactttacctttgctttgttgtcatttttaaatttact caaggaaatactaggatttaaaaaaaaattccttgagtaaatttaaattgttatcatgtttttgaggat tattttcagatttttttagtttaatgaaaatttaccaaagtaaagaccagcagcagaatgataagtaaa gacctgtaagacaccttgaaggtcatggagtagaacttccatcccaagcagatgaggatttatttaatc tcaaagacctccaggaggggacattccccaactgtccttgttaactcattttcagaacatatttattag catattttacatgtaatttggatcttcatgttaaatttaacatcagtggagatggaaaataagcatatc gccttgtctttgaaatagccctatattgttagattgtttcttaggcttctttaccctgggttaagcagt cctaatactttagcatttattctacatctagtgtactaatttaaaaaaatcagttctgaaaaatttcta agaactttcttcaagttccaagctgtgaaatctagaacaggtcaaagtgccttattaacgtactgtact gtgtagtgtcttgaagagacactttgcgctgaggcaagttctgagggcattgggtggccttgggaagat atttatgcagtttagaacctggagaattgattagataactaatcataaggaaacgtcacatatttttgg tactataaaaaagtggagaaataatgcctatttgcaaagatttgatttaaacatagaaacaactttatt tggcttccaattttaagaatttacagcagtaaaggggaacagtctaattgaagtagactgcctatgcaa tagtctctgtatatttacttttgacaagttaattcaatgtgtactatagttttgtttctttgaagaggt ttgaatagtgcacccattttaatctgt Underline: exon 1 SEQ ID NO 7: MTEYKLVVVGAVGVGKSALTIQLIQNHFVDEYDPTIE DSYRKQVVIDGETCLLDILDTAGQEEYSAMRD amino acid QYMRTGEGFLCVFAINNTKSFEDIHHYREQIKRVKDSEDVPMVLVGNKCDLPSRTVDTKQAQDLARSYG sequence of IPFIETSAKTRQRVEDAFYTLVREIRQYRLKKISKEEKTPGCVKIKKC mutant KRAS Underline: KRAS exon 1 c.G35 > T Shade: G12V mutation SEQ ID NO 8: aaacttgtggtagttggagctgg KRAS target site (23 nt, including PAM)

The DNA fragments cleaved by Cas9 were electrophoresed on 1.5% agarose gel and then identified by staining with EtBr. As a result, it was confirmed that a complex of the isolated and purified Cas9 protein and the guide RNA precisely cleaves only the target site of the DNA satisfying the PAM sequence of 5′-NGG-3′ (see FIGS. 2a and 2b ).

The mutation of the KRAS gene, which is one of the major mutations of cancer genes, is an important biomarker that can be detected on cfDNA. In particular, in the mutation of KRAS, the mutation whereby the 35th nucleic acid of the cDNA is changed from G to T, so that the 12nd amino acid of the KRAS protein is replaced from glycine (G) to valine (V) is important (SEQ ID NO 5 and SEQ ID NO 7). For the mtDNA wherein the 35th guanosine is substituted with thymidine, the base sequence corresponding to the PAM of Cas9 on the target DNA is changed to NGT. Cas9, which specifically recognizes NGG as a PAM sequence, recognizes only wt KRAS specifically from wt KRAS and mt KRAS (35G>T) and cleaves the DNA (SEQ ID NO 8).

The guide RNA has a target sequence corresponding to the 1572-nt position on the 2787-nt DNA including the wild-type KRAS gene (SEQ ID NO 4). It was confirmed through electrophoresis that the Cas9 complexed with guide RNA produces a long 1572-nt fragment and a short 1215-nt fragment by cleaving the KRAS gene on the 2787-nt DNA (see top of FIG. 2b and top of FIG. 3b ). However, even when the guide RNA was used, the mtKRAS gene wherein the PAM sequence is changed to 5′-NGT-3′ was not cleaved by Cas9 (see bottom of FIG. 2b and bottom of FIG. 3b ).

Example 4. Selective Removal of Wild-Type Cell-Free DNA Only

Experiment was conducted to investigate whether the wild-type cell-free DNA is degraded selectively by a Cas protein and exonuclease.

Target DNAs (wild-type cell-free DNA and mutant-type cell-free DNA isolated from the blood of a cancer patient) were amplified by PCR using a primer 5′-end protected with a phosphothioate bond (Table 2) and a Phusion polymerase. After purifying the wild-type DNA (wtDNA) and the mutant DNA (mtDNA) using a PCR purification kit (Qiagen Cat ID: 28104), a DNA sample was prepared by mixing the wtDNA and the mtDNA at a ratio of 90:10 (wtDNA ratio 90%; mtDNA ratio 10%), 99:1 (wtDNA ratio 99%; mtDNA ratio 1%), 99.9:0.1 (wtDNA ratio 99.9%; mtDNA ratio 0.1%), 99.99:0.01 (wtDNA ratio 99.99%; mtDNA ratio 0.01%) or 99.999:0.001 (wtDNA ratio 99.999%; mtDNA ratio 0.001%). 500 ng of SpCas9 and 100 ng of a guide RNA were bound at 37° C. for 5 minutes, and the resulting product was reacted with 100 ng of the purified double-stranded DNA (dsDNA) at 37° C. for 60 minutes in a buffer consisting of 50 mM (pH 7.9) potassium acetate, 20 mM Tris-acetate, 10 mM magnesium acetate and 1 mM DTT (dithiothreitol, reducing agent).

TABLE 2 Primer name Sequence(5′-3′) KRAS_F ACACTCTTTCCCTACACGACG (SEQ ID NO 14) CTCTTCCGATCTACATTTTCA TTATTTTTATTATAAGGCCTG CTGAAAATGA KRAS_R GTGACTGGAGTTCAGACGTGT (SEQ ID NO 15) GCTCTTCCGATCTTTAAAACA AGATTTACCTCTATTGTTGGA TCATATTCG EGFR_F ACACTCTTTCCCTACACGACG (SEQ ID NO 16) CTCTTCCGATGGGACTCTGGA TCCCAGAAGG EGFR_R GTGACTGGAGTTCAGACGTGT (SEQ ID NO 17) GCTCTTCCGATCAGCTGCCAG ACATGAGAAA Phosphothioate primer_F A*C*A*CTCTTTCCCTACACG (SEQ ID NO 18) ACGCTCTTCCGATCT Phosphothioate primer_R G*A*C*TGGAGTTCAGACGTG (SEQ ID NO 19) TGCTCTTCCGATC *phosphothioate bond

After the reaction, reaction was conducted additionally at 37° C. for 60 minutes by adding exonuclease T7 and exonuclease T. The DNA fragments treated with Cas9 and the exonuclease were identified by electrophoresis on 1.5% agarose gel or by Sanger sequencing and next-generation sequencing after PCR amplification.

The 2787-nt DNA including the KRAS gene has both ends protected with phosphothioate bonds (see step 1 in FIG. 3a ). The DNA with both ends protected with phosphothioate bonds was not degraded even after being treated with the exonuclease. However, when the DNA was cleaved by Cas9, the unprotected end of the nucleic acid was exposed to the exonuclease and the DNA was degraded (see steps 2 and 3 in FIG. 3a ). When the guide RNA targeting the KRAS gene was used, only the wt KRAS gene satisfying the PAM sequence of 5′-NGG-3′ was cleaved selectively by Cas9. It was confirmed through electrophoresis that the wt KRAS DNA cleaved by Cas9 was completely removed by treating with exonuclease T7 and exonuclease T (see the top rightmost line in FIG. 3b ). However, the mt KRAS DNA not cleaved by Cas9 was not degraded even after treatment with the exonuclease because both ends were protected with phosphothioate bonds (the bottom rightmost line in FIG. 3b ).

Example 5. Investigation of Detection Limit for Target DNA

The DNA remaining in trace amounts when the target DNA was removed selectively was identified by sequencing. Experiment was conducted by mixing the wtDNA and the mtDNA at different ratios in order to investigate the detection limit for the DNA in trace amounts. After mixing the wt KRAS DNA and the mt KRAS DNA with both ends were protected with phosphothioate bonds at a ratio of 90:10 (wtDNA ratio 90%; mtDNA ratio 10%), 99:1 (wtDNA ratio 99%; mtDNA ratio 1%), 99.9:0.1 (wtDNA ratio 99.9%; mtDNA ratio 0.1%), 99.99:0.01 (wtDNA ratio 99.99%; mtDNA ratio 0.01%) or 99.999:0.001 (wtDNA ratio 99.999%; mtDNA ratio 0.001%) and then treating with Cas and an exonuclease, the finally obtained sample was subjected to sequencing (see FIG. 4).

As seen from FIG. 4, it was confirmed through NGS sequencing that the ratio of the mtDNA increased even in the sample treated only with Cas9. However, when the initial ratio of the mtDNA in the sample was 1% or lower, the ratio of the finally detected mtDNA was decreased remarkably. Considering that the ratio of the mtDNA in cfDNA is 0.01% or lower in general, it is not easy to identify the presence of the mtDNA when the target DNA is removed with Cas9 only. Thus, experiment was conducted as follows to investigate the detection limit for the target DNA.

When the sample treated with Cas9 and the exonuclease was analyzed by Sanger sequencing, it was found out that the region of KRAS c.35 guanosine was read as thymidine. When treated only with Cas9, the histograms of guanosine and thymidine were observed at the same time in the region corresponding to the 35th nucleic acid in the sample where the initial ratio of mtDNA was 1% (NGS result mtDNA: 44%), and the sequence of mtDNA could not be observed in the sample where the initial ratio of mtDNA was 1% or lower (see Cas_treatment on the left side of FIG. 5). However, when treated with Cas9, exonuclease T and exonuclease T7, the mutant sequence could be observed by Sanger sequencing even in the sample where the initial ratio of mtDNA was 0.01% (see Cas+ExoT+ExoT7_treatment on the right side of FIG. 5).

As seen from FIG. 5, it was confirmed that the presence of mtDNA could be identified clearly through NGS for the sample treated with Cas9, exonuclease T and exonuclease T7 even when the initial ratio of mtDNA in the sample was 0.01% or lower (the detection limit of mtDNA only when Cas9 is used was 1%). Accordingly, in the present disclosure, the detection limit is increased by at least 100 times as compared to the method of cleaving the target DNA using only the Cas9 system.

Example 6. Removal of Various Target DNAs Using Multiplex System

Various target DNAs were removed using a multiplex system as described below. The EGFR sequence is shown in Table 3.

TABLE 3 In-vitro DNA substrate Sequence SEQ ID NO 9: ctcataagcataagcgcgtgtgatgtgccccaaccaaacgaccgccatgcacaacttccctaccggagt sequence of wild- tttcaatccagttaataggcgtggaaacagacatagaaattgtgtttgttgaaaggtagctgttcagtt type EGFR aaagaacacctgtatcagagcctgtgtttctaccaacttctgtcaagctctgtagagaaggcgtacatt (2813 nt) tgtccttccaaatgagctggcaagtgccgtgtcctggcacccaagcccatgccgtggctgctggtcccc ctgctgggccatgtctggcactgctttccagcatggtgagggctgaggtgacccttgtctctgtgttct tgtcccccccagcttgtggagcctcttacacccagtggagaagctcccaaccaagctctcttgaggatc ttgaaggaaactgaattcaaaaagatcaaagtgctgggctccggtgcgttcggcacggtgtataaggta aggtccctggcacaggcctctgggctgggccgcagggcctctcatggtctggtggggagcccagagtcc ttgcaagctgtatatttccatcatctactttactctttgtttcactgagtgtttgggaaactccagtgt ttttcccaagttattgagaggaaatcttttataaccacagtaatcagtggtcctgtgagaccaattcac agaccaaaggcatttttatgaaaggggccattgaccttgccatggggtgcagcacagggcgggaggagg gccgcctctcaccgcacggcatcagaatgcagcccagctgaaatgggctcatcttcgtttgcttcttct agatcctctttgcatgaaatctgatttcagttaggcctagacgcagcatcattaaattctggatgaaat gatccacacggactttataacaggctttacaagcttgagattcttttatctaaataatcagtgtgattc gtggagcccaacagctgcagggctgcgggggcgtcacagcccccagcaatatcagccttaggtgcggct ccacagccccagtgtccctcaccttcggggtgcatcgctggtaacatccacccagatcactgggcagca tgtggcaccatctcacaattgccagttaacgtcttccttctctctctgtcatag ggactctggatccca gaaggtgagaaagttaaaattcccgtcgctatcaaggaattaagagaagcaacatctccgaaagccaac aaggaaatcctcgat gtgagtttctgctttgctgtgtgggggtccatggctctgaacctcaggcccacc ttttctcatgtctggcagctgctctgctctagaccctgctcatctccacatcctaaatgttcactttct atgtctttccctttctagctctagtgggtataactccctccccttagagacagcactggcctctcccat gctggtatccaccccaaaaggctggaaacaggcaattactggcatctacccagcactagtttcttgaca cgcatgatgagtgagtgctcttggtgagcctggagcatgggtattgtttttggtattttttggatgaag aaatggaggcataaagaaattggctgacccttatatggctgggatagggtttaagccccttgttatttc tgactctgaaacttgcattcaattcactccaccaagttatctcatctttgaaatggctttttttaaagg tgcctagaatatgatggcgtgcagtctataaactgttgcccaccttctgtactttctctcagaataatt cacattcttctccagtgtctgttgattgttactttgtggaataagttcttggaaaattccacaagatta ttgttatcttcttactaccaattctattgaactttctccaccttctctgggccttccccagccagtggt gggaagatgctggctggagtctgacagagcctcttctacactggcctgggcttgctgtgagttggtgga aacctttgctcttgtcccaacacagagcaagtgaaagaggaggtcaaggggctcaggcagcggactagg gaagcagaatcgaggaaaaggaaaaatggctgacttattacctcaaaactctagagaatttagttgatc ttacagccaagaaggacaaaagccagagagtaatatcctccgcctcatgtctaacccacagaatacata gcaagtaaagagaacatgggcctttataaaaatgtcttaagatacaattttttaattggaggaaatcta cagtttaattttctctgggcagcttttcttccttttattatagtaggggaaatcccatgttgatatact tctaaatgaaagatgatgaattgatataatacaataaaaaatctgtaaaattgatgatatacttatcaa gaaaaattagctttcattttaacggtttacaaattgagtcaagtcctagtaacaaaatgttaagtctat taacataaccacaagaaatacaggaagacgggcaatctgtgaagcctttcacttacaatctctggcccc tcacctgtgctgtgtaggaaaatctttgtgcacaatttgcttccttaattcattttttattcattcaac acattctaataaattatacaaaatcatgttgaaatgtgaatttcagtggtatttataaatgcagtgtga ggagggtttggatgtattctaagacaatagttgtgctttgggaaggaagcagtgttcactgaaaagtgc ccccaggaccttttaattggaggaaatatgcttctgtggagttggaaatgggg Underline: exon SEQ ID NO 10: MRPSGTAGAALLALLAALCPASRALEEKKVCQGTSNKLTQLGTFEDHFLSLQRMFNNCEVVLGNLEITY amino acid VQRNYDLSFLKTIQEVAGYVLIALNTVERIPLENLQIIRGNMYYENSYALAVLSNYDANKTGLKELPMR sequence of wild- NLQEILHGAVRFSNNPALCNVESIQWRDIVSSDFLSNMSMDFQNHLGSCQKCDPSCPNGSCWGAGEENC type EGFR QKLTKIICAQQCSGRCRGKSPSDCCHNQCAAGCTGPRESDCLVCRKFRDEATCKDTCPPLMLYNPTTYQ MDVNPEGKYSFGATCVKKCPRNYVVTDHGSCVRACGADSYEMEEDGVRKCKKCEGPCRKVCNGIGIGEF KDSLSINATNIKHFKNCTSISGDLHILPVAFRGDSFTHTPPLDPQELDILKTVKEITGFLLIQAWPENR TDLHAFENLEIIRGRTKQHGQFSLAVVSLNITSLGLRSLKEISDGDVIISGNKNLCYANTINWKKLFGT SGQKTKIISNRGENSCKATGQVCHALCSPEGCWGPEPRDCVSCRNVSRGRECVDKCNLLEGEPREFVEN SECIQCHPECLPQAMNITCTGRGPDNCIQCAHYIDGPHCVKTCPAGVMGENNTLVWKYADAGHVCHLCH PNCTYGCTGPGLEGCPTNGPKIPSIATGMVGALLLLLVVALGIGLFMRRRHIVRKRTLRRLLQERELVE PLTPSGEAPNQALLRILKETEFKKIKVLGSGAFGTVYK GLWIPEGEKVKIPVAIKELREATSPKANKEI LD EAYVMASVDNPHVCRLLGICLTSTVQLITQLMPFGCLLDYVREHKDNIGSQYLLNWCVQIAKGMNYL EDRRLVHRDLAARNVLVKTPQHVKITDFGLAKLLGAEEKEYHAEGGKVPIKWMALESILHRIYTHQSDV WSYGVTVWELMTFGSKPYDGIPASEISSILEKGERLPQPPICTIDVYMIMVKCWMIDADSRPKFRELII EFSKMARDPQRYLVIQGDERMHLPSPTDSNFYRALMDEEDMDDVVDADEYLIPQQGFFSSPSTSRTPLL SSLSATSNNSTVACIDRNGLQSCPIKEDSFLQRYSSDPTGALTEDSIDDTFLPVPEYINQSVPKRPAGS VQNPVYHNQPLNPAPSRDPHYQDPHSTAVGNPEYLNTVQPTCVNSTFDSPAHWAQKGSHQISLDNPDYQ QDFFPKEAKPNGIFKGSTAENAEYLRVAPQSSEFIGA Underline: EGFR exon Shade: Del. E746-A750 SEQ ID NO 11: ctcataagcataagcgcgtgtgatgtgccccaaccaaacgaccgccatgcacaacttccctaccggagt mutant EGFR tttcaatccagttaataggcgtggaaacagacatagaaattgtgtttgttgaaaggtagctgttcagtt c.2235-2249 del. aaagaacacctgtatcagagcctgtgtttctaccaacttctgtcaagctctgtagagaaggcgtacatt (2798 nt) tgtccttccaaatgagctggcaagtgccgtgtcctggcacccaagcccatgccgtggctgctggtcccc ctgctgggccatgtctggcactgctttccagcatggtgagggctgaggtgacccttgtctctgtgttct tgtcccccccagcttgtggagcctcttacacccagtggagaagctcccaaccaagctctcttgaggatc ttgaaggaaactgaattcaaaaagatcaaagtgctgggctccggtgcgttcggcacggtgtataaggta aggtccctggcacaggcctctgggctgggccgcagggcctctcatggtctggtggggagcccagagtcc ttgcaagctgtatatttccatcatctactttactctttgtttcactgagtgtttgggaaactccagtgt ttttcccaagttattgagaggaaatcttttataaccacagtaatcagtggtcctgtgagaccaattcac agaccaaaggcatttttatgaaaggggccattgaccttgccatggggtgcagcacagggcgggaggagg gccgcctctcaccgcacggcatcagaatgcagcccagctgaaatgggctcatcttcgtttgcttcttct agatcctctttgcatgaaatctgatttcagttaggcctagacgcagcatcattaaattctggatgaaat gatccacacggactttataacaggctttacaagcttgagattcttttatctaaataatcagtgtgattc gtggagcccaacagctgcagggctgcgggggcgtcacagcccccagcaatatcagccttaggtgcggct ccacagccccagtgtccctcaccttcggggtgcatcgctggtaacatccacccagatcactgggcagca tgtggcaccatctcacaattgccagttaacgtcttccttctctctctgtcatag ggactctggatccca gaaggtgagaaagttaaaattcccgtcgctatcaagacatctccgaaagccaacaaggaaatcctcgat gtgagtttctgctttgctgtgtgggggtccatggctctgaacctcaggcccaccttttctcatgtctgg cagctgctctgctctagaccctgctcatctccacatcctaaatgttcactttctatgtctttccctttc tagctctagtgggtataactccctccccttagagacagcactggcctctcccatgctggtatccacccc aaaaggctggaaacaggcaattactggcatctacccagcactagtttcttgacacgcatgatgagtgag tgctcttggtgagcctggagcatgggtattgtttttggtattttttggatgaagaaatggaggcataaa gaaattggctgacccttatatggctgggatagggtttaagccccttgttatttctgactctgaaacttg cattcaattcactccaccaagttatctcatctttgaaatggctttttttaaaggtgcctagaatatgat ggcgtgcagtctataaactgttgcccaccttctgtactttctctcagaataattcacattcttctccag tgtctgttgattgttactttgtggaataagttcttggaaaattccacaagattattgttatcttcttac taccaattctattgaactttctccaccttctctgggccttccccagccagtggtgggaagatgctggct ggagtctgacagagcctcttctacactggcctgggcttgctgtgagttggtggaaacctttgctcttgt cccaacacagagcaagtgaaagaggaggtcaaggggctcaggcagcggactagggaagcagaatcgagg aaaaggaaaaatggctgacttattacctcaaaactctagagaatttagttgatcttacagccaagaagg acaaaagccagagagtaatatcctccgcctcatgtctaacccacagaatacatagcaagtaaagagaac atgggcctttataaaaatgtcttaagatacaattttttaattggaggaaatctacagtttaattttctc tgggcagcttttcttccttttattatagtaggggaaatcccatgttgatatacttctaaatgaaagatg atgaattgatataatacaataaaaaatctgtaaaattgatgatatacttatcaagaaaaattagctttc attttaacggtttacaaattgagtcaagtcctagtaacaaaatgttaagtctattaacataaccacaag aaatacaggaagacgggcaatctgtgaagcctttcacttacaatctctggcccctcacctgtgctgtgt aggaaaatctttgtgcacaatttgcttccttaattcattttttattcattcaacacattctaataaatt atacaaaatcatgttgaaatgtgaatttcagtggtatttataaatgcagtgtgaggagggtttggatgt attctaagacaatagttgtgctttgggaaggaagcagtgttcactgaaaagtgcccccaggacctttta attggaggaaatatgcttctgtggagttggaaatgggg SEQ ID NO 12: MRPSGTAGAALLALLAALCPASRALEEKKVCQGTSNKLTQLGTFEDHFLSLQRMFNNCEVVLGNLEITY amino acid VQRNYDLSFLKTIQEVAGYVLIALNTVERIPLENLQIIRGNMYYENSYALAVLSNYDANKTGLKELPMR sequence of mutant NLQEILHGAVRFSNNPALCNVESIQWRDIVSSDFLSNMSMDFQNHLGSCQKCDPSCPNGSCWGAGEENC EGFR c.2235-2249 QKLTKIICAQQCSGRCRGKSPSDCCHNQCAAGCTGPRESDCLVCRKFRDEATCKDTCPPLMLYNPTTYQ del. MDVNPEGKYSFGATCVKKCPRNYVVTDHGSCVRACGADSYEMEEDGVRKCKKCEGPCRKVCNGIGIGEF KDSLSINATNIKHFKNCTSISGDLHILPVAFRGDSFTHTPPLDPQELDILKTVKEITGFLLIQAWPENR TDLHAFENLEIIRGRTKQHGQFSLAVVSLNITSLGLRSLKEISDGDVIISGNKNLCYANTINWKKLFGT SGQKTKIISNRGENSCKATGQVCHALCSPEGCWGPEPRDCVSCRNVSRGRECVDKCNLLEGEPREFVEN SECIQCHPECLPQAMNITCTGRGPDNCIQCAHYIDGPHCVKTCPAGVMGENNTLVWKYADAGHVCHLCH PNCTYGCTGPGLEGCPTNGPKIPSIATGMVGALLLLLVVALGIGLFMRRRHIVRKRTLRRLLQERELVE PLTPSGEAPNQALLRILKETEFKKIKVLGSGAFGTVYK GLWIPEGEKVKIPVAIKTSPKANKEILD EAY VMASVDNPHVCRLLGICLTSTVQLITQLMPFGCLLDYVREHKDNIGSQYLLNWCVQIAKGMNYLEDRRL VHRDLAARNVLVKTPQHVKITDFGLAKLLGAEEKEYHAEGGKVPIKWMALESILHRIYTHQSDVWSYGV TVWELMTFGSKPYDGIPASEISSILEKGERLPQPPICTIDVYMIMVKCWMIDADSRPKFRELIIEFSKM ARDPQRYLVIQGDERMHLPSPTDSNFYRALMDEEDMDDVVDADEYLIPQQGFFSSPSTSRTPLLSSLSA TSNNSTVACIDRNGLQSCPIKEDSFLQRYSSDPTGALTEDSIDDTFLPVPEYINQSVPKRPAGSVQNPV YHNQPLNPAPSRDPHYQDPHSTAVGNPEYLNIVQPTCVNSTFDSPAHWAQKGSHQISLDNPDYQQDFFP KEAKPNGIFKGSTAENAEYLRVAPQSSEFIGA Underline: EGFR exon Del. E746-A750 SEQ ID NO 13: tcttaattccttgatagcgacgg EGFR target site (23 nt, including PAM)

Several target DNAs were amplified by PCR using a primer 5′-end protected with a phosphothioate bond (Table 2) and a Phusion polymerase. A target DNA sample was prepared by mixing KRAS DNA and EGFR DNA, which were separated and purified using a PCR purification kit, at a ratio of 1:1. 500 ng of Cas9 and 50 ng of guide RNAs targeting KRAS and EGFR (SEQ ID NO 3) were bound by mixing for 5 minutes. The resulting product was reacted with 100 ng of the purified target DNA sample at 37° C. for 60 minutes in a buffer consisting of 50 mM (pH 7.9) potassium acetate, 20 mM Tris-acetate, 10 mM magnesium acetate and 1 mM DTT.

After the reaction with Cas9, reaction was conducted additionally at 37° C. for 60 minutes by adding exonuclease T7 and exonuclease T. The DNA fragments treated with Cas9 and the exonuclease were identified by electrophoresis on 1.5% agarose gel or by Sanger sequencing and next-generation sequencing after PCR amplification.

When the guide RNA targeting KRAS DNA and the guide RNA targeting EGFR DNA were mixed and bound to Cas9, it was confirmed that each target DNA of a mixture of wt KRAS DNA (2787 nt) and wt EGFR DNA (2813 nt) at a ratio of 1:1 was cleaved by each guide RNA, and that only the cleaved DNAs were removed completely by the exonuclease through electrophoresis (see middle of FIG. 7b ). On the contrary, the DNA sample wherein mt KRAS and mt EGFR were mixed at a ratio of 1:1 was not cleaved by Cas9 and was not degraded by the exonuclease (see bottom of FIG. 7b ).

As descried above, it was confirmed through electrophoresis that several target DNAs can be removed simultaneously by using a multiplexing system using guide RNAs targeting different DNAs. Also, it was confirmed that several DNAs in trace amounts can be identified by NGS.

Example 7. Investigation of Detection Limit for Various Target DNAs Using Multiplexing System

The detection limit of a multiplexing system was investigated by NGS analysis using DNA samples obtained by mixing wtDNA and mtDNA for the KRAS gene and the EGFR gene at different ratios. After mixing wt KRAS DNA, wt EGFR DNA, mt KRAS DNA and mt EGFR DNA with both ends protected with phosphothioate bonds at ratios of 90:10 (KRAS mtDNA ratio: 10%, EGFR mtDNA ratio: 10%, wt KRAS DNA ratio: 90%, wt EGFR DNA ratio: 90%), 99:1 (KRAS mtDNA ratio: 1%, EGFR mtDNA ratio: 1%, wt KRAS DNA ratio: 99%, wt EGFR DNA ratio: 99%), 99.9:0.1 (KRAS mtDNA ratio: 0.1%, EGFR mtDNA ratio: 0.1%, wt KRAS DNA ratio: 99.9% wt EGFR DNA ratio: 99.9%), 99.99:0.01 (KRAS mtDNA ratio: 0.01%, EGFR mtDNA ratio: 0.01%, wt KRAS DNA ratio: 99.99%, wt EGFR DNA ratio: 99.99%), 99.999:0.001 (KRAS mtDNA ratio: 0.001%, EGFR mtDNA ratio: 0.001%, wt KRAS DNA ratio: 99.999%, wt EGFR DNA ratio: 99.999%) and treating with Cas9 and an exonuclease, the finally obtained sample was subjected to sequencing.

As in the experiment using the guide RNA for KRAS only (experiment for a single target DNA), the mutant sequence could not be detected normally with the multiplexing system in the sample wherein 1% or less mtDNA was present when only Cas9 was used. However, when treated with Cas9 and the exonuclease together, the mtDNA could be detected effectively with the multiplexing system (see FIG. 8 and FIG. 9).

Referring to FIG. 9, Cas9 orthologues recognize PAM of different sequences. spCas9 can cleave only the target DNA having the 5′-NGG-3′ sequence near the 3′ end. The NGG base sequence on the DNA is called the PAM sequence of spCas9. The PAM sequences of nmCas9, saCas9, cjCas9, AsCpf1 and FnCpf1 are recognized respectively as 5′-NNNGMTT-3′, 5′-NNGRRT-3′, 5′-NNNVRYAC-3′, 5′-TTTN-3′ and 5′-KYTV-3′. The different Cas9 orthologues can operate normally only when the PAM sequence is satisfied. If the Cas9 orthologue is used for multiplexing, the limitation of the variety of targetable DNAs due to the limitation of PAM sequence can be overcome. As shown in the figure, various cancer mutations can be detected beyond the limitation of the genes that can be targeted with spCsa9 by using various Cas9 orthologues.

Those skilled in the art will appreciate that the conceptions and specific embodiments disclosed in the foregoing description may be readily utilized as a basis for modifying or designing other embodiments for carrying out the same purposes of the present disclosure. Those skilled in the art will also appreciate that such equivalent embodiments do not depart from the spirit and scope of the disclosure as set forth in the appended claims. 

1. A mutant cell-free DNA isolation kit comprising: a composition for amplifying a wild-type cell-free DNA and a mutant cell-free DNA, which comprises a 5′ end-protected primer; a guide RNA specific for the wild-type cell-free DNA; a Cas protein for cleaving the wild-type cell-free DNA; and an exonuclease for removing the wild-type cell-free DNA.
 2. The mutant cell-free DNA isolation kit according to claim 1, wherein the mutant cell-free DNA is a DNA comprising a cancer-specific mutation, and the kit is for isolating a mutant cell-free DNA from a wild-type cell-free DNA and a mutant cell-free DNA comprised in a blood, plasma or urine sample isolated from an individual suspected with cancer.
 3. The mutant cell-free DNA isolation kit according to claim 1, wherein the Cas protein is Streptococcus pyogenes Cas9 (SpCas9), Streptococcus thermophilus Cas9 (StCas9), Streptococcus pasteurianus (SpaCas9), Campylobacter jejuni Cas9 (CjCas9), Staphylococcus aureus (SaCas9), Francisella novicida Cas9 (FnCas9), Neisseria cinerea Cas9 (NcCas9), Neisseria meningitis Cas9 (NmCas9), or CRISPR-associated endonuclease in Prevotella and Francisella 1 (Cpf1).
 4. The mutant cell-free DNA isolation kit according to claim 1, wherein the guide RNA is a dual RNA (dualRNA) or an sgRNA (single-chain RNA) comprising a crRNA (CRISPR RNA) and a tracrRNA (trans-activating crRNA).
 5. The mutant cell-free DNA isolation kit according to claim 1, wherein the guide RNA comprises two or more guide RNAs specific for a plurality of wild-type cell-free DNAs.
 6. The mutant cell-free DNA isolation kit according to claim 1, wherein the 5′ end-protected primer has the 5′ end of the primer protected with a phosphothioate bond and the composition for amplifying DNA is a PCR composition.
 7. A mutant genotype analysis method comprising: i) a step of amplifying a wild-type cell-free DNA and a mutant cell-free DNA in an isolated sample comprising at least one wild-type cell-free DNA and at least one mutant cell-free DNA using a 5′ end-protected primer; ii) a step of cleaving only the amplified wild-type cell-free DNA by treating with a Cas protein and a guide RNA recognizing specifically to the wild-type cell-free DNA; iii) a step of removing only the cleaved wild-type cell-free DNA by treating the sample comprising the mutant cell-free DNA and the cleaved cell-free DNA with an exonuclease; iv) a step of amplifying the mutant cell-free DNA remaining in the sample; and v) a step of analyzing the amplified mutant cell-free DNA.
 8. The mutant genotype analysis method according to claim 7, wherein the isolated sample comprising at least one wild-type cell-free DNA and at least one mutant cell-free DNA is a blood, plasma or urine sample isolated from an individual suspected with cancer.
 9. The mutant genotype analysis method according to claim 7, wherein the mutant cell-free DNA is a DNA comprising cancer-specific mutation, and the analysis of the mutant cell-free DNA is for providing information for diagnosis of cancer.
 10. The mutant genotype analysis method according to claim 7, wherein the 5′ end-protected primer has the 5′ end of the primer protected with a phosphothioate bond.
 11. The mutant genotype analysis method according to claim 7, wherein the Cas protein is Streptococcus pyogenes Cas9 (SpCas9), Streptococcus thermophilus Cas9 (StCas9), Streptococcus pasteurianus (SpaCas9), Campylobacter jejuni Cas9 (CjCas9), Staphylococcus aureus (SaCas9), Francisella novicida Cas9 (FnCas9), Neisseria cinerea Cas9 (NcCas9), Neisseria meningitis Cas9 (NmCas9), or CRISPR-associated endonuclease in Prevotella and Francisella 1 (Cpf1).
 12. The mutant genotype analysis method according to claim 7, wherein the guide RNA is a dual RNA (dualRNA) or an sgRNA (single-chain RNA) comprising a crRNA (CRISPR RNA) and a tracrRNA (transactivating crRNA).
 13. The mutant genotype analysis method according to claim 7, wherein the amplification is performed by PCR. 